SESSION TYPE: Cardiovascular Student/Resident Case Report Posters II
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Atrial septal defect (ASD) is the most common type of congenital heart disease in children, discovered incidentally in adults with complications like pulmonary hypertension. Their manifestation during pregnancy carries high risk of mortality and hence pregnancy is contraindicated.
CASE PRESENTATION: 31 year old pregnant woman (38 weeks) with no significant past medical history and three previous normal pregnancies presents in active labor and had a normal vaginal delivery. During sterilization procedure she was hypoxic with oxygen saturation around 88% that improved with supplemental oxygen. She was totally asymptomatic. Physical examination then revealed normal S1, a fixed split of S2 and soft systolic ejection murmur. Lungs were clear to auscultation. Chest xray and CT scan of chest showed enlarged main pulmonary arteries, central and interlobar arteries. Connective tissue disease work up was negative and HIV test non-reactive. She had no family history of heart problems or sudden cardiac death. She denied smoking and drugs. Echocardiography with bubble study uncovered the interatrial shunt and RV systolic pressures of 80-90mm of Hg. Transesophageal echocardiography showed large atrial septal defect (ASD) measuring 2.9x2 cm with bidirectional flow, predominantly left to right with calculated qp:qs 2.3:1. 6 weeks post pregnancy she had a right heart catheterization which showed mean pulmonary artery pressure of 61mm of Hg and borderline significant vasoreactivity to adenosine challenge. She was diagnosed of Type I Pulmonary Arterial Hypertension secondary to Ostium Secundum type of ASD. Prophylactic measures included wearing knee length stockings continuously and filtering all her IVs during hospitalization. Screening of her first degree relatives was initiated. She was referred for ASD closure.
DISCUSSION: Pulmonary Hypertension is defined as elevated mean pulmonary artery pressure greater than 25mm of Hg at rest. Type I pulmonary artery hypertension (PAH) is thought to be secondary to disease affecting the small pulmonary muscular arterioles and includes congenital heart defects, connective tissue disease, HIV infection and drug effects. Previously undiagnosed congenital heart defects like ASD could lead to PAH with decreased functional status and enhanced mortality due to Eisenmengarization. Hemodynamic changes during pregnancy like increased blood volume and pressure changes can lead to shunt reversal which is more catastrophic. When pregnant women with congenital heart disease have an initial successful pregnancy, the long-term ill effects are generally not cumulative.
CONCLUSIONS: Successive pregnancies generally entail the same but not greater risk. Likewise our patient had not one, nor two, but four normal pregnancies.
1) Child, JS. Management of Pregnancy and contraception in Congenital Heart Disease. In: Congenital Heart Disease in Adults, 3rd ed, Perloff, JK, Child, JS, Aboulhosn, J (Eds), Saunders/Elsevier, 2009
DISCLOSURE: The following authors have nothing to disclose: Sashank Kolli, Bhavith Aruni, Clifton Clarke
No Product/Research Disclosure InformationAdvocate Illinois Masonic Medical Center, Chicago, IL